HomeMy WebLinkAboutPermit Sidewalk 2013-7-3 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
OREGON Building / Public Works Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-PW201 3-0 01 39
www.springfield-or.gov permitcenter @springfield-ar.gov
PROJECT STATUS: Issued ISSUED: 07/03/2013 EXPIRES: 12/29/2013
STATUS DATE: 07/03/2013 APPLIED: 07/03/2013
SITE ADDRESS: 404 C ST 1,Springfield,OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1703352410600 TYPE OF STRUCTURE:
PROJECT DESCRIPTION: Repair of Sidewalk
OWNER: COLEMAN-FRASER SUSAN Phone Number:
ADDRESS: 404 C ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
41 NORTHWEST MOBILE HOME SERVICE INC CCB 107081 07/17/2014 541-689-3151
INSPECTIONS REQUIRED
•
Inspections
9508 Sidewalk
By signature, I state and agree,that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the
Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO
OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further
certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree
to ensure that all required inspections are requested at the proper time,that each address is readable from the street,that the
permit card is located at the front of th- . ._-rty, and the approved set of plans will remain on the site at all times during
•nstruction.
•
t_s ' 5 , 1, 3
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
NOTICE: follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001-
AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by
COMMENCED OR IS ABANDONED FOR calling the center. (Note: the Notification 180 DAY number for the Oregon Utility Notification
AY PERIOD. Center is 1-800-332-2344).
Springfield Building Permit 7/3/2013 10:23:42AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
a 1' TRANSACTION RECEIPT Springfield OR 97477
OREGON
811-PW2013-00139 541-726-3753
www springfield-or gov 404 C ST 1 permacenter@springfield-or gov
RECEIPT NO: 2013001435 RECORD NO: 811-PW2013-00139 DATE:07/03/2013
DEscRirrioN Adcoblit;coberRANs...copti: AMOUNT DUL.
Sidewalk up though 90 Feet 201-00000-428060 1142 102 00
Technology fee(5%of permit total) 100-00000-425605 2099 5.10
TOTAL DUE: 107.10
L-PAYMENTtYWE pistvorc CASHIER:KwEsoN tammESts AmouNT Nam 1/2:1i,
Check Susan Coleman Fraser Sidewalk Repair 107.10
9617
TOTAL PAID: 107.10
City" 61 Springfield
Driveway/Sidewalk Permit Application
Application Date:
225 Fifth Street,Springfield,Oregon 97477 SPRINGFIELD
Permit Number Transportation&Engineering Section,Public Works Department
—__ Phone: 541 726-3753
Issue Date:
OREGON
SITE INFORMATION
Location of Work: 2--n ( '•5
Applicant Phone: 15-1 6 2 6 -
Address: 0 Tax Map
City: Stag ZIP: 1 --I Tax Lot
Subdivision ------- -- ---- _-------- -
Owner:
Phone:
Address:
City: State: ZIP:
REQUESTED PERMITS:
Fees
El Sidewalk Amount of sidewalk in excess of 90 feet 5102.00 @$0.09 SF
1idewalk Repair $18.00
Curb Cut/Driveway: Number of Driveways X$102.00 1st Cut X$54 2nd Cut
IT Multiple Permit Discount each:(Maximum 2) $35
Multi permit discount good for one site and one site inspection only
applies to 2nd and 3rd permits only. Not sidewalk repairs
Ei 5%Technology fee
El Proof of Insurance: $500,000 Minimum if work is done by property owner. Total due with permit$
CONTRACTOR'S INFORMATION I f SL) I —
Name:' N Uil \ e / 1 1 /Mr c s j Phone: 6 -3 ) 5 J
Address: 3g7'i (✓Y'OSS Sine - -
City: State: Q(�ZIP: cI7t.[G?-
Contractor Registration# 10.1(A) Expiration date:
Project Supervisor Phone: trjti/ —g7 -3/s7
INSPECTIONS:
An inspection request should be made prior to pouring concrete,after the proposed work has been formed and made ready to pour.
Curb cut and sidewalk inspections call: 541 726-3769(recording)State your designated City job number/permit number,job address,
type of inspection requested,and when you will be ready for inspection. Contractor's or Owner's name and phone number. Requested
received before 7:00 am will be made the same day,requests after 7:00 am will be made the next working day. Inspections are to be
called in after excavations are made and form work is in place,but prior to pouring concrete.
You are required to call: The Lane Utilities Coordinating Council's"One Call Number" 1-800-332-2344,
48 hours before before digging.
SIGNATURE: